贝达喹啉联合二线抗结核治疗痰菌阳性耐多药肺结核的长期效果及对患者免疫功能的影响  

Long-term effect of Bedaquiline combined with second-line anti-tuberculosis therapy on sputum-positive multi-drug resistant tuberculosis and its influence on immune function of patients

作　　者：张宇 何岚 周观林 蒋凛 ZHANG Yu;HE Lan;ZHOU Guanlin;JIANG Lin(Department of Pharmacy,Ganzhou Fifth People's Hospital,Jiangxi Province,Ganzhou341000,China;Department of Tuberculosis,Ganzhou Fifth People's Hospital,Jiangxi Province,Ganzhou341000,China;Department of Internal Medicine,Ganzhou Fifth People's Hospital,Jiangxi Province,Ganzhou341000,China)

机构地区：[1]江西省赣州市第五人民医院药剂科,江西赣州341000 [2]江西省赣州市第五人民医院结核科,江西赣州341000 [3]江西省赣州市第五人民医院内科,江西赣州341000

出　　处：《中国当代医药》2024年第20期103-106,110,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202312103)。

摘　　要：目的探讨贝达喹啉联合二线抗结核治疗痰菌阳性耐多药肺结核(MDR-TB)的长期效果及对患者免疫功能的影响。方法选取2020年1月至2022年1月赣州市第五人民医院收治的100例痰菌阳性MDR-TB患者作为研究对象,按照随机数字表法分为贝达喹啉组(50例)和对照组(50例),对照组采用环丝氨酸、氯法齐明、利奈唑胺及莫西沙星联合治疗,贝达喹啉组在对照组基础上加用贝达喹啉治疗。比较两组患者治疗后的效果、治疗长期效果、免疫功能、不良反应情况。结果治疗3个月后,贝达喹啉组的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗1年后,贝达喹啉组患者的痰液菌转阴率、空洞闭合率、病灶吸收率均高于对照组,差异有统计学意义(P<0.05)。治疗后,贝达喹啉组患者的转化生长因子-β(TGF-β)、γ干扰素(IFN-γ)、血清肿瘤坏死因子-α(TNF-α)值均高于对照组,差异有统计学意义(P<0.05)。治疗期间两组的不良反应发生率比较,差异无统计学意义(P>0.05)。结论贝达喹啉联合二线抗结核治疗能提高痰菌阳性MDR-TB患者临床疗效和长期效果,并对改善其免疫功能有积极意义,但联合使用药物安全性有待提高。Objective To explore the long-term effect of Bedaquiline combined with second-line anti-tuberculosis in the treatment of sputum-positive multi-drug resistant tuberculosis(MDR-TB)and its influence on immune function of patients.Methods A total of 100 patients with sputum-positive MDR-TB admitted to Ganzhou Fifth People's Hospital from January 2020 to January 2022 were selected as research subjects and were divided into 50 cases in Bedaquiline group and 50 cases in control group according to the random number table method.The control group was given combined therapy with cyCloserine,Clofazimine,Linezolid and Moxifloxacin,and the Bedaquiline group was additionally given Bedaquiline on the basis of the control group.The clinical efficacy,long-term effect,immune function and adverse reactions were compared between both groups.Results After 3 months of treatment,the total effective rate of treatment in Bedaquiline group was better than that in control group,with a significant difference(P<0.05).The sputum bacteria negative conversion rate,cavity closure rate and lesion absorption rate in Bedaquiline group after 1 year of treatment were higher than those in control group,and the differences were statistically significant(P<0.05).After treatment,the levels of transforming growth factor-β(TGF-β),interferon-γ(IFN-γ)and serum tumor necrosis factor-α(TNF-α)in Bedaquiline group were higher compared with those in control group,and the differences were statistically significant(P<0.05).The differences in the incidence rates of adverse reactions were not statistically significant between the two groups during treatment(P>0.05).Conclusion Bedaquiline combined with second-line anti-tuberculosis therapy can enhance the clinical efficacy and long-term effect in patients with sputum-positive MDR-TB,and it has positive significance on improving the immune function,but the safety of the combined therapy needs to be improved.

关 键 词：贝达喹啉 抗结核药物 痰菌阳性耐多药肺结核 免疫功能 

分 类 号：R521[医药卫生—内科学]